Type B aortic dissection is an uncommon yet potentially catastrophic clinical event that mandates prompt recognition and expeditious treatment. Patient survival depends on early and accurate diagnosis and prompt medical or surgical treatment. Unfortunately, when type B aortic dissection is associated with end-organ ischemia, medical treatment may not prove beneficial, with patients addressed to surgery; recently, either percutaneous fenestration or primary endovascular aortic repair has been proposed as a valuable alternative to surgery in this scenario. Although the ideal endograft has not emerged and improvement in the long-term behavior of the devices is required, endograft placement is becoming the first choice in patients with complicated type B aortic dissection requiring emergency treatment.